Do You Really Need Rotator Cuff Surgery? - Hand Therapy Secrets

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Do You Really Need Rotator Cuff Surgery?

Rotator Cuff Surgery

One question we normally get from people with shoulder pain is, do I really need rotator cuff surgery? 

I’m gonna answer that for you because there’s a couple of different layers that when people ask me this question, this is the process that I go through with them so that I can help you make a decision about whether, you know, surgery’s the option for you or therapies option for you. Because I think as a therapist really it’s just about empowering you, right, as a person going through shoulder pain, I sort of wish that when I was going through some of, you know, my injuries, that, you know, someone took the time to do this for me. So if you were suffering with shoulder pain or rotator cuff injury.

My name is Huang. I’m an occupational therapist and certified hand therapist. I specialize not just in hands, but I specialize in shoulders and so much more. But for this topic, shoulders, so do you really need a rotator or cuff surgery?

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What is a Rotator Cuff?

Rotator cuff is essentially the tendon that’s attached to the muscles that help to move your shoulder, right? it’s muscle, like, so you have a muscle belly, and then you have tendons attached on each end. And the rotator cuff is just a tear-off. There’s four muscles, but they all kind of come together in your shoulder and help to hold this bone, the head of the humerus into this little socket. You really need all four muscles, all four tendons to work really well together in this, what we call a shoulder complex so that you can live pain-free, you can be active, you can do things over your head, you can push, you can pull, you can sleep.

Those are really important things, right? So, do you really need rotator or cuff surgery? The difference there comes in a couple of, I would say essentially three things you want to think about, age, activity level, and your ultimate commitment to the process, right? So, after the age of 40 there, I mean, there’s tons of research on this to show that after the age of 40, we just have normal wear and tear of the tendons, especially a very particular tendon called the supraspinatus because of the way it sits, your scapula has this acromion, it’s like this little hook, and the head of the humerus is this bone right here, a lot of times if it’s not working well, just keeps hitting. So, bone and bone keep hitting, and over time there’s some wear and tear of it.

So, you might have, after the age of 40, a lot of people have small little tears. So, whether you need rotator cuff surgery or not depends on the severity of the tear. So, let’s say you have a full tear, like, you fell on it, you had an accident, it is just torn. Usually, if you have a full tear, what happens with that tear is the muscle, right, the muscle pulls back to its original spot. Normally, if you have a full rotator cuff tear, I do recommend having surgery because tendons cannot heal on their own, right? You need to take that muscle, take that tendon, and pull it back, and sew or hammer it back into place. That’s what the surgeons do, right? So, if you have a full tear and you are relatively young, relatively active then you want to, you know, I would recommend having a rotator cuff surgery because once that muscle pulls back and it sits there for a certain length of time, your window of opportunity to have surgery to fix it goes away.

I once worked with a man who I met at around 55. He tore his rotator cuff in both shoulders for whatever reason. And he was told in his 40s, like, I guess, it was like he was 45, let’s say, they told him you need rotator cuff surgery, and he had a full tear. So, imagine the tear, it’s like a rubber band you cut on one end, it’s gonna come back to where it originally is, you know, inserted or originated. So, it, you know, retracted back and they recommended surgery for him at that time. And I don’t think that anyone really fully explained, or maybe he just chose not to have surgery because he was scared, but he chose not to have surgery. And by the time he was 55, 10 years later, he was like, okay, I’m ready to have that surgery now and now he’s no longer a candidate. By the time I saw him, he had pain in both shoulders. He was really limited in what he could do. I mean, he could move it, right? So, he had decent motion to get dressed and do all this stuff, but he couldn’t be more physically active, and he was starting to have pain that just would not subside.

He didn’t understand the concept of the muscle pulling back. And you cut it, it’s like a rubber band, it’s gonna pull back to its original, right? So, this muscle starts over here, ends over here, and it’s torn, it’s gonna come all the way back to its original. And then what happens with it over a period of time is when you are not using it, the body just starts to deposit fat there and it no longer keeps its ability to be, how do you call it, elastic, right? Because your muscles only get long and only get short. So, he lost that ability, so he was no longer a candidate.

So, if you have a full rotator cuff tear, you know, talk to your surgeon, talk to your therapist about what the surgery is like, the protocols, and we can go into that and another one, but majority of the time people have what’s called a partial tear, or you might have shoulder pain that’s starting to cause a little tear, but you don’t yet really fully have a tear. And so, do you really need rotator cuff surgery? So, if you don’t have a full tear, then one of the first things to consider is what we call conservative treatment. Conservative treatment means can I take care of this problem without having surgery. Can I take care of this problem without constantly having injections, right?

And if you are, you know, aged, again, if you, I mean, I’m in my 40s and I plan to live a really long time, you know, God willing, and I wanna feel healthy, I want to feel pain-free, I want to be very active.

So, if you’re in your 40s, 50s and 60s and even 70s, you, I mean, I had a patient who was in her 80s and she was still playing golf, you know, and she was able to fix her shoulder pain and not need any surgery, right? And people kept telling her like, oh, you’re in your 80s, you just slow down. Like, this is normal. You’re aging. She goes, “Yeah, but just the other day I was still in my 80s and I was still playing golf.” So that didn’t make sense to her. So she was like, I knew I needed to do something.

She just, I just wasn’t sure what it was I needed to do. So, if, you know, age can be a component, whether you need surgery or not, but the first line of action, essentially, is to try conservative treatment. And that means therapy. The right kind of therapy is the thing that’s gonna make the difference whether you can actually avoid surgery or not, right? The right kind of therapy just not, like, any therapy. Your activity level. So, usually, it determines someone’s activity level. And I had some one of my patients who was in his 60s, he was 65 and he asked me this question, “Do I really need rotator cuff surgery?” And based on the review of his MRI, based on his arm movement, you don’t even need the MRI, but he wanted to have it because he wanted to know for sure.

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What Happens When I Get an MRI After Rotator Cuff?

What happens when you go and get an MRI? You get an MRI, the surgeon’s gonna say, “You need surgery.” Right? Because that’s what MRIs do. They determine your need for surgery. So, it’s, yep, they’re like, “You have a tear. We don’t know how big the tear is, but you have a tear.” Which you’re always gonna end up finding in someone who’s over 40. So, they’re like, “Yep, you need surgery.” And he was like, “I don’t know why.” I mean, he even had his surgery scheduled. And then he came to me and he was like, “Do I really need this?” And I said, “If you haven’t really tried conservative therapy then it’s something to consider.” So, he’s very active, he works in his yard, he’s active with his children. Overall just a really active guy, and he’s 65.

And ultimately, I was like, “Ultimately, what’s your commitment to the process?” Right? “Do you want to avoid it?” So, some people actually don’t, right? Some people don’t. They would just rather have the surgery. Like, I know tons of people are like, “Nope, if I need surgery, let me have the surgery.” Right? “I have a partial tear, I have a small tear, let me have the surgery.” So, they would rather have the surgery and then work with the recovery process, which is a minimum of three months to a year for recovery, right? A minimum of three months to a year for recovery. And we can talk about…that’s another video, right? But if you already, like, you don’t really wanna avoid it, you wanna have surgery, this video isn’t really for you, right?

But if you are committed, right, you have to be committed to avoiding the surgery, it is possible as long as you have a partial tear, right? And it is possible based on the type of therapy that you have. And then here are the two things that I look for when I’m working with someone so that I can know as I’m working with them, you can avoid surgery. Or at some point I’m like, “No, you need surgery.” Right? So, the thing to look for is one, you wanna get rid of the pain. So, getting rid of the pain is actually funny enough, it’s the easiest thing, right? You can get rid of pain relatively fast if you do the right kind of therapy, right? So, if you’re going somewhere and you’re just getting a hot pack, e-stim, they’re putting you on an arm bike, they’re having you do pulleys, you know, things and they’re not really watching how you are moving, the order in which you are exercising, you may not feel the results.

And so that might make you think, “Oh, I need to go and have surgery.” Done correctly, you’re looking for two things. You’re looking for week on week on week, a certain progress of reduced pain, right? So, I usually tell my patients, based on the way I work, that within three to four weeks, we should have a solid answer, right, a solid answer if we can avoid it. I usually know if we’re working together, if they’re committed, and finding the movements that work. I test against the movements at work, and you’re actually doing the one or two things that I’m showing you. I usually see it like around two weeks, around three weeks, and then, you know, we can progress from there. So, one, it’s, you know, we can get rid of the pain, that’s relatively easy. Two, two, the thing is, can we keep it? Can we keep it?

So there’s a certain progress that we’re making in order to be able to keep it? Once you reduce the pain, then the strengthening is very very particular. And then you have to continue to progress. If you’re doing the same through exercises and you’re not progressing, you might plateau and not be able to keep it. So, every person and everybody and their activity level is different. That’s why it’s so important for you if you’re suffering with shoulder pain and you’re considering rotator cuff surgery is, you know, closely working with your therapist, whether it be a physical therapist, an occupational therapist, a certified hand therapist, someone who specializes in works with shoulders, they’re willing to spend the time to talk to you, to monitor how you’re doing things, to give you the exercises in a particular order that’s actually gonna help you see progress.

It’s when you don’t see any progress week on week and being able to keep it is when I would say, “Okay, we’re able to get rid of the pain, but we’re not able to keep it.

So, now, you have to make the hard decision because having surgery that is not like from an accident is a personal choice, right? Is a personal choice.” Some people have health concerns and health issues, and they’re just like, “I don’t wanna have a surgery.” Right? So, what are you willing to live with? Another thing that I do at my clinic where, you know, if you know, you might be watching this, and if you’re in Miami, we can help you if you’re watching somewhere else, talk to your therapist, create a plan with them. And one of the things that I do is I look above and below, right? I look above and below.

So, shoulder problems isn’t just shoulder problems. We are full living human beings and we use all of our body. There’s not one part of our body that we’re not using, okay? We’re using it all. And the way you use your body impacts your recovery. So, make sure you look above and below. I remember working with a woman way back in my early days where I didn’t know how to do this. I’ll be perfectly honest, it was very early on in my career. She had tried conservative therapy and she had an MRI and she had a very, very, very small tear. And the doctor didn’t wanna do the surgery, but after months and months of therapy and she just could not get rid of the pain, she ultimately decided to go in and have the surgery, and she wanted to have the surgery, and she came to therapy.

And we got her motion back. I mean, everything was good except for she still had that nagging little pain. And I’ll tell you what, if your therapist is not looking above and below, you might not be getting the results, right? So, with the shoulder, one of the most important things that we could do as therapists is look above and below. So, above and below, or actually the shoulder is, you know, the shoulder comprises the of the clavicle as well, the shoulder blade, and then this humerus, right? But this whole complex then now sits on your thoracic spine, and we have 12 of those bones, right? So, we gotta look at how the bones of your thorax essentially moving, right? And then we have to look at your cervical spine. Your cervical spine encompasses seven of those bones.

You always want to always see seven, and we wanna make sure we’re looking and saying, “Are they moving well?” Right? And the muscles, like, you know, this is how I teach my students, but the muscles that encompass that help us to move our shoulders pain-free, right? We have huge expansive muscles in the front and we have expansive muscles in the back, and they all kind of come back to the spine, right? So, your lower back, your mid back, your upper back, and your cervical spine. So, when you are working with your therapist, work with them, be honest with them, tell them what is going on past injuries and little things can make a difference. So, usually, when I work with my shoulder patients, I’m like, “Okay, tell me what’s going on, I need the history of your back, I need, you know, history of your neck because all of these things make a really big difference in overall getting great results for your shoulder.

Final Thoughts

So, that’s why I say the majority of the patients we work with, majority of them were able to help avoid rotator cuff surgery. Majority of them were able to avoid having injections, right? There’s a small percentage of people who need rotator cuff surgery. They’re the ones who fall. They’re the ones who’ve had, like, chronic issues over a period of time that they didn’t deal with for a really long time, and their joints might be really messy inside. But they, like I said, one of my other patients, he just waited 10 years, and then he would just, you know, kind of not be a candidate for rotator cuff surgery. So, I would encourage you, if you are suffering from shoulder pain and you think it is a rotator cuff injury, you can go talk to your therapist that you trust. If you are in the local Miami area, my name is Huang Tran, I have a therapy clinic in Doral. It’s called Hands On Therapy Services. I’ll include the links below so that you can go check it out.

We have some free guides that talk about, you know, what are some of the things that you can do, what are some of the things that you should avoid. And I invite you to come and talk to our specialist and see if you are a candidate for our type of therapy services and can you really fully avoid rotator cuff surgery. We’ve been able to help hundreds of people avoid it. So, all it does is it starts with a conversation.

 Let me know if this video has helped you, and share with a friend who’s going through shoulder pain. See if you can help them avoid surgery as well. Thanks for tuning in and like the button subscribe for more. I’m gonna put out some more videos about shoulder pain, and other shoulder conditions. 

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About Hoang Tran – an expert in physical & occupational therapy  

Hoang Tran is a Miami certified hand therapist , the owner of Hands-on Therapy Services and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!). 

The aim of her occupational therapy practice is to bring patients back to full functionality, without pills, injections or surgery. Occupational and Physical Therapy are both offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care. 

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Hoang Tran

“I help Occupational Therapists develop their skills and grow their confidence in Hand Therapy. No matter where you are on your journey, build a happy and fulfilling career of your dreams. I’ll help you.”